No. 282-Rural Maternity Care



      To provide an overview of current information on issues in maternity care relevant to rural populations .


      Medline was searched for articles published in English from 1995 to 2012 about rural maternity care . Relevant publications and position papers from appropriate organizations were also reviewed .


      This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities .


      • 1.
        Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible.
      • 2.
        The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful.
      • 3.
        Rural maternity care services should be supported through active policies aligned with these recommendations.
      • 4.
        While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women.
      • 5.
        The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally.
      • 6.
        Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women.
      • 7.
        Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills.
      • 8.
        Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in rural settings. Remuneration models should facilitate interprofessional collaboration.
      • 9.
        Practitioners skilled in neonatal resuscitation and newborn care are essential to rural maternity care.
      • 10.
        Training of rural maternity health care providers should include collaborative practice as well as the necessary clinical skills and competencies. Sites must be developed and supported to train midwives, nurses, and physicians and provide them with the skills necessary for rural maternity care. Training in rural and northern settings must be supported.
      • 11.
        Generalist skills in maternity care, surgery, and anaesthesia are valued and should be supported in training programs in family medicine, surgery, and anaesthesia as well as nursing and midwifery.
      • 12.
        All physicians and nurses should be exposed to maternity care in their training, and basic competencies should be met.
      • 13.
        Quality improvement and outcome monitoring should be integral to all maternity care systems.
      • 14.
        Support must be provided for ongoing, collaborative, interprofessional, and locally provided continuing education and patient safety programs.

      Key Words

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        • Iglesias S.
        • Grzybowski S.
        • Klein M.C.
        • Gagné G.P.
        • Lalonde A.
        Rural obstetrics. Joint position paper on rural maternity care. Joint Working Group of the Society of Rural Physicians of Canada (SRPC), The Maternity Care Committee of the College of Family Physicians of Canada (CFPC), and the Society of Obstetricians and Gynaecologists of Canada (SOGC).
        Can Fam Physician. 1998; 44: 831-843
        • Kralj B.
        Measuring rurality—RI02008 BASIC: methodology and results.
        (Toronto ON: Ontario Medical Association Economics Department; [cited 2012 May 8]; Available at:)
        • Kornelsen J.
        • Grzybowski S.
        • Iglesias S.
        Is rural maternity care sustainable without general practitioner surgeons?.
        Can J Rural Med. 2006; 11: 218-220
        • Sutherns R.
        • Bourgeault I.L.
        Accessing maternity care in rural Canada: there's more to the story than distance to a doctor.
        Health Care Women Int. 2008; 29: 863-883
        • Kornelsen J.
        • Grzybowski S.
        Safety and community: the maternity care needs of rural parturient women.
        J Obstet Gynaecol Can. 2005; 27: 554-561
        • Leeman L.
        • Leeman R.
        Do all hospitals need cesarean delivery capability? An outcomes study of maternity care in a rural hospital without on-site cesarean capability.
        J Fam Pract. 2002; 51: 129-134
        • Grzybowski S.
        • Stoll K.
        • Kornelsen J.
        Distance matters: a population based study examining access to maternity services for rural women.
        BMC Health Serv Res. 2011; 11: 147
        • Lisonkova S.
        • Sheps S.B.
        • Janssen P.A.
        • Lee S.K.
        • Dahlgren L.
        • Macnab Y.C.
        Birth outcomes among older mothers in rural versus urban areas: a residence-based approach.
        J Rural Health. 2011; 27: 211-219
        • Society of Obstetricians and Gynaecologists of Canada
        • College of Family Physicians of Canada; Society of Rural Physicians of Canada
        Number of births to maintain competence.
        Can Fam Physician. 2002; 48: 751-758
        • Kornelsen J.
        • Stoll K.
        • Grzybowski S.
        Stress and anxiety associated with lack of access to maternity services for rural parturient women.
        Aust J Rural Health. 2011; 19: 9-14
        • Zelek B.
        • Orrantia E.
        • Poole H.
        • Strike J.
        Home or away? Factors affecting where women choose to give birth.
        Can Fam Physician. 2007; 53
        • Grzybowski S.
        • Kornelsen J.
        • Cooper E.
        Rural maternity care services under stress: the experiences of providers.
        Can J Rural Med. 2007; 12: 89-94
        • Iglesias A.
        • Iglesias S.
        • Arnold D.
        Birth in Bella Bella: emergence and demise of a rural family medicine birthing service.
        Can Fam Physician. 2010; 56: e233-40
        • Grzybowski S.
        • Kornelsen J.
        • Schuurmans N.
        Planning the optimal level of local maternity service for small rural communities: a systems study in British Columbia.
        Health Policy (New York). 2009; 92: 149-157
        • Kornelsen J.
        • Moola S.
        • Grzybowski S.
        Geographic induction of rural parturient women: is it time for a protocol?.
        J Obstet Gynaecol Can. 2007; 29: 583-585
        • Kornelsen J.
        • Kotaska A.
        • Waterfall P.
        • Willie L.
        • Wilson D.
        The geography of belonging: the experience of birthing at home for First Nations women.
        Health Place. 2010; 16: 638-645
        • Kornelsen J.
        • Kotaska A.
        • Waterfall P.
        • Willie L.
        • Wilson D.
        Alienation and resilience: the dynamics of birth outside their community for rural First Nations women.
        J Aborig Health. 2011; 7: 55-64
        • Medves J.M.
        • Davies B.L.
        Sustaining rural maternity care—don't forget the RNs.
        Can J Rural Med. 2005; 10: 29-35
        • Peterson W.E.
        • Medves J.M.
        • Davies B.L.
        • Graham I.D.
        Multidisciplinary collaborative maternity care in Canada: easier said than done.
        J Obstet Gynaecol Can. 2007; 29: 880-886
        • Society of Obstetricians and Gynaecologists of Canada
        A national birthing initiative for Canada.
        (Ottawa ON: SOGC; [cited 2012 May 14]; Available at:)
        • MacKinnon K.A.
        Labouring to nurse: the work of rural nurses who provide maternity care.
        Rural Remote Health. 2008; 8: 1047
        • MacKinnon K.
        Learning maternity: the experiences of rural nurses.
        Can J Nurs Res. 2010; 42: 38-55
        • MacKinnon K.
        Rural nurses' safeguarding work: reembodying patient safety.
        ANS Adv Nurs Sci. 2011; 34: 119-129
        • Deaton B.J.
        • Essenpreis H.
        • Simpson K.R.
        Assessing competence. Meeting the unique needs of nurses in small rural hospitals.
        AWHONN Lifelines. 1998; 2: 33-37
        • Kornelsen J.
        Rural midwifery: overcoming barriers to practice.
        Can J Midwifery Res Pract. 2009; 8: 6-11
        • Canadian Nurses Association
        • Canadian Association of Midwives
        • Canadian Association of Perinatal and Women's Health Nurses
        Joint Position Statement.
        (Nurses and midwives collaborate on client-centred care; [cited 2012 May 14]; Available at:)
        • Couchie C.
        • Sanderson S.
        • Society of Obstetricians and Gynaecologists of Canada
        A report on best practices for returning birth to rural and remote aboriginal communities.
        J Obstet Gynaecol Can. 2007; 29 (SOGC Policy Statement no. 188, December 2007): 250-260
        • Van Wagner V.
        • Epoo B.
        • Nastapoka J.
        • Harney E.
        Reclaiming birth, health, and community: midwifery in the Inuit villages of Nunavik, Canada.
        J Midwifery Womens Health. 2007; 52: 384-391
        • Dooley J.
        • Kelly L.
        • St Pierre-Hansen N.
        • Antone I.
        • Guilfoyle J.
        • O'Driscoll T.
        Rural and remote obstetric care close to home: program description, evaluation and discussion of Sioux Lookout Meno Ya Win Health Centre obstetrics.
        Can J Rural Med. 2009; 14: 75-79
        • Society of Obstetricians and Gynaecologists of Canada
        Returning birth to Aboriginal, rural, and remote communities.
        J Obstet Gynaecol Can. 2010; 32 (SOGC Policy Statement no. 251, December 2010): 1186-1188
        • National Aboriginal Council of Midwives
        2012 statement.
        (Montreal: NACM; Available at:)
        Date: 2012
        Date accessed: September 17, 2012
        • Stretch N.C.
        Community obstetrics: a new look at group obstetrical care in rural communities.
        Can J Rural Med. 2002; 7: 183-190
        • Osmun W.E.
        • Poenn D.
        • Buie M.
        Dilemma of rural obstetrics. One community's solution.
        Can Fam Physician. 1997; 43: 1115-1119
        • Orrantia E.
        • Poole H.
        • Strike J.
        • Zelek B.
        Evaluation of a novel model for rural obstetric care.
        Can J Rural Med. 2010; 15: 14-18
        • Aubrey-Bassler K.
        • Newbery S.
        • Kelly L.
        • Weaver B.
        • Wilson S.
        Maternal outcomes of cesarean sections: do generalists' patients have different outcomes than specialists' patients?.
        Can Fam Physician. 2007; 53: 2132-2138
        • Deutchman M.E.
        • Sills D.
        • Connor P.D.
        Perinatal outcomes: a comparison between family physicians and obstetricians.
        J Am Board Fam Pract. 1995; 8: 440-447
        • Iglesias S.
        • Bott N.
        • Ellehoj E.
        • et al.
        Outcomes of maternity care services in Alberta, 1999 and 2000: a population-based analysis.
        J Obstet Gynaecol Can. 2005; 27: 855-863
        • Pollett W.G.
        The future of surgery—Santayana or Ford.
        Can J Surg. 2000; 43: 347-352
        • Toguri C.
        • Jong M.
        • Roger J.
        Needs of specialists in rural and remote Canada.
        Can J Rural Med. 2012; 17: 56-62
        • Angle P.
        • Kurtz Landy C.
        • Murthy Y.
        • Cino P.
        Key issues and barriers to obstetrical anesthesia care in Ontario community hospitals with fewer than 2,000 deliveries annually.
        Can J Anaesth. 2009; 56: 667-677
        • Douglas J.
        • Preston R.
        Provision of obstetric anesthesia: throwing down the gauntlet!.
        Can J Anaesth. 2009; 56: 631-635
        • Health Canada
        Family-centred maternity and newborn care: national guidelines. [Internet].
        (Ottawa ON: Health Canada; [cited 2012 May 18]; Available at:)
        • World Health Organization
        World Health Report 2005.
        (Make every mother and child count. Geneva: WHO; [cited 2012 May 25]; Available at:)
        Date: 2005
        Date accessed: August 10, 2012
        • McGrath S.K.
        • Kennell J.H.
        A randomized controlled trial of continuous labor support for middle-class couples: effect on cesarean delivery rates.
        Birth. 2008; 35: 92-97
        • Zaichkin J.
        • Kattwinkel J.
        • McGowan J.
        • American Heart Association
        • American Academy of Pediatrics
        Textbook of neonatal resuscitation.
        6th ed. American Academy of Pediatrics, Elk Grove Village IL2011
        • Fetus and Newborn Committee
        • Canadian Paediatric Society
        Position statement. Levels of neonatal care.
        Paediatr Child Health. 2006; 11: 303-306
        • Mitchell A.
        • Niday P.
        • Boulton J.
        • Chance G.
        • Dulberg C.
        A prospective clinical audit of neonatal resuscitation practices in Canada.
        Adv Neonatal Care. 2002; 2: 316-326
        • Foster K.
        • Craven P.
        • Reid S.
        Neonatal resuscitation educational experience of staff in New South Wales and Australian Capital Territory hospitals.
        J Paediatr Child Health. 2006; 42: 16-19
        • Henry J.A.
        • Edwards B.J.
        • Crotty B.
        Why do medical graduates choose rural careers?.
        Rural Remote Health. 2009; 9: 1083
        • Rourke J.T.
        • Incitti F.
        • Rourke L.L.
        • Kennard M.
        Relationship between practice location of Ontario family physicians and their rural background or amount of rural medical education experience.
        Can J Rural Med. 2005; 10: 231-240
        • Stretch N.
        • Voisin A.
        • Dunlop S.
        Survey of rural family physician- obstetricians in Southwestern Ontario.
        Can J Rural Med. 2007; 12: 16-21
        • Maudlin R.K.
        • Newkirk G.R.
        Family medicine spokane rural training track: 24 years of rural-based graduate medical education.
        Fam Med. 2010; 42: 723-728
        • Coonrod R.A.
        • Kelly B.F.
        • Ellert W.
        • Loeliger S.F.
        • Rodney W.M.
        • Deutchman M.
        Tiered maternity care training in family medicine.
        Fam Med. 2011; 42: 631-637
        • Graves L.
        • Hutten-Czapski P.
        An approach to maternity care education for Canadian family medicine residents. A discussion paper of the Maternity and Newborn Care Committee.
        (Mississauga ON: College of Family Physicians of Canada)2006
        • Ratcliffe S.D.
        • Newman S.R.
        • Stone M.B.
        • Sakornbut E.
        • Wolkomir M.
        • Thiese S.M.
        Obstetric care in family practice residencies: a 5-year follow-up survey.
        J Am Board Fam Pract. 2002; 15: 20-24
        • Delzell Jr, J.E.
        • Ringdahl E.N.
        The University of Missouri rural obstetric network: creating rural obstetric training sites for a university-based residency program.
        Fam Med. 2003; 35: 243-245
        • Committee on Data Standards for Patient Safety
        Aspden P. Corrigan J.M. Wolcott J. Erickson S.M. Patient safety: achieving a new standard for care. National Academies Press, Washington DC2004
        • Kohn L.
        • Corrigan J.
        • Donaldson M.
        To err is human: building a safer health system.
        National Academy Press, Washington DC2000
        • Emanuel L.
        • Berwick D.
        • Conway J.
        • et al.
        What exactly is patient safety?.
        in: Henriksen K. Battles J.B. Keyes M.A. Grady M.L. Advances in patient safety: new directions and alternative approaches. Assessment. Vol. 1. Agency for Healthcare Research and Quality, Rockville MD2008
        • Salus Global Corporation
        MOREOB Managing Obstetrical Risk Efficiently. [Internet].
        (London ON: Salus; [cited 2012 May 15]; Available at:)
        Date: 2012
        Date accessed: August 10, 2012
        • Thanh N.X.
        • Jacobs P.
        • Wanke M.I.
        • Hense A.
        • Sauve R.
        Outcomes of the introduction of the MOREOB continuing education program in Alberta.
        J Obstet Gynaecol Can. 2010; 32: 749-755